Appointment with clinical psychologist

This post is dated the day I had the appointment but I’m writing it the day after. I felt good after the appointment and that it had gone well.

B didn’t give a plan/agenda for the appointment which is the first time that’s happened. Maybe she only expected to talk about how I had got on with the food diary and to see what happened. I’m a bit worried that I rambled too much and wasted time. Writing that has made me realise that that is a common worry of mine and that I should actually say it to her. Perhaps I’ve got the wrong end of the stick or perhaps she could suggest some solutions.

She asked me how I had been over the week since she last saw me and how I had found the food diary. She noticed that O the rat had nibbled the bottom of it! I said that writing down all the food had initially made me count up all the calories and think it was too much but that I had stopped doing that. That’s not wholly true as I am still more aware now about what I am eating but that has both good and bad results. It is providing motivation to restrict how much I eat seeing it written down but then again it is also providing motivation to eat snacks and eat more regularly overall. I am also eating more healthily I think since someone else is seeing my choices.

I told her that I had binged badly the day before. It was 2555 calories. I was tempted to lie and exaggerate how many calories I ate but didn’t. I lied and said I had tried to make myself sick but hadn’t been sick. I didn’t try to make myself sick. I did think about it but couldn’t be bothered – I’m not really sure why. Apathy, disgust (I’ve read some horrible descriptions), fear? I said I felt physically unwell afterwards with abdominal pain, gut symptoms (I was trying to avoid describing this further) and sore throat. The abdominal pain, diarrhoea and having a sore peri-anal area was true. She was particularly interested in how I found the physical symptoms relieved the emotional ones and asked if that was a common thing for me. It is (the whole “translating” thing) and I said it was a distraction. I think she was also suggesting that it sounded like I was trying to punish myself too which I wasn’t too happy with at the time but now I think sounds right. I’m trying to find some sympathy for my poor body going through this rather than the usual hate and disgust. If I was talking to friend after they had binged I would make an extra effort to be supportive and nice to them and probably try to preempt my friend from beating themselves up about what they had done. There is also the whole issue of how I’d much rather have a physical illness than a psychological one as I think other people, and myself, would accept it better.

We talked about what had triggered the binge. I said looking back on my food diary I hadn’t eaten enough the two days before and also hadn’t slept the night before. Also my boyfriend J is away this week. It’s really quite horrible, pathetic, bizarre, etc, how little I see other people. I don’t see a lot of I but since we moved to B I don’t see anyone other than professionals. For someone who really thrives on social contact I’m being a fucking idiot letting this situation continue.

The last things B said about the food diary were that I was doing well in the days that I ate but even in those days I should eat more calories. I’m a sad cow but I loved hearing that. It made me feel like real ED patient, which is pretty sick, but it was great to hear that I get to eat more. However, I found out today that that isn’t actually as easy as it sounds. I’m running out of hours to eat in but I’m not hungry and don’t want to eat. Also a 75g portion (recommended amount) of brown rice was too much for me to eat and I threw the last part of it away. I am supposed to be aiming to maintain my weight not loose weight. Furthermore, to loose weight safely I need to learn how to maintain my weight and eat healthily so I can find where in my diet it is safe to reduce by a small amount what I eat. Then loose weight slowly without triggering disordering eating behaviours.

Bollocks, just re-read the last paragraph: “it’s great to hear that I get to eat more”. Get to? Who decides these arbitrary rules that I have for all these different things? I decide them. And I don’t even have to have them.

I said I had realised that to get myself feeling better I have to improve my brain’s biochemistry. Thoughts, feelings and behaviours come from the brain. Medication and lifestyle changes affect brain biochemistry. I can change things and make them better. This is a really simple idea but it’s never really struck me before until I saw gem61580‘s videos. My psychologist B said that Maslow’s hierarchy of needs shows the same idea.

So what I need to do is:

good diet

regular exercise

regulate sleep cycle

see friends and family

increase activity

avoid alcohol and drugs

regular meditation

That’s too much to work on all at once so I need to prioritise. I expect B will want me to do ‘activity scheduling’ at some point which will help with this list. Also I am seeing my consultant Dr S on Monday and I am going to talk to her about the quetiapine and my sleep. I asked B about the quetiapine/sleep/depersonalisation issue and she said that as I had been doing much better recently and had only been more stable for a short time she would not favour change at the moment (I’m paraphrasing of course).

In regard to sleep, B suggested cutting down or stopping caffeine. I don’t drink coffee but drink a lot of tea. Stopping caffeine would also have the benefit of reducing blood sugar swings (the mechanism is caffeine causes adrenalin to be released which then sharply increases blood glucose which will trigger insulin release and blood glucose fall). According to B, more than five cups of coffee a day is a problem. I love tea but I can’t tell the difference between decaf and normal. Bit of a no-brainer there: swap to decaf.

I mentioned that the term I was trying to remember at the last appointment was emotional incontinence. I know I don’t have that and in fact don’t think I even have emotional lability (unless my sex hormones or prolactin is seriously buggered). I have the ‘tearfulness’ symptom of depression. I’m sad. My heart hurts too much for me, other people and animals. I had talked at the last appointment about how this had happened to me in the past when I was recovered from depressive episodes. In my mind it was the numb part of me getting better. B told me that that would fit in with schema therapy though it was a part that was later on in the psychotherapy course. My schemas produce the Vulnerable Child mode but that is too painful to feel all the time, especially as a child, so you need another mode to cover them. My main mode is the Detached Protector which is the fancy name for all my avoidance behaviours like depersonalisation, binge-eating, sleeping too much, alcohol and drugs, self-harm, perfectionism, etc. There’s also the Bully mode which has generated a lot of negative automatic thoughts for me and the Angry Child mode though B said that didn’t really apply to me. The aim is to ‘heal’ the schemas so you don’t need the unhealthy modes anymore but instead can have the Healthy Adult Mode. There’s a lot more to it than that but a big thing I got from it is that the tearfulness is the Vulnerable Child mode and basically I want to be kind to ‘it’ (i.e. me). If I comfort and soothe ‘it’ with healthy things then I’ll feel better and not get the bad things from the unhealthy/avoidance behaviours.

When I got home after the appointment I threw out the remaining binge food (about 3500 calories). I have beautiful yellow and peach miniature roses instead :-)